Pollution and health: A neglected issue
Dr. Trevor Hancock
30 October 2017
Perhaps the most startling claim made by the Lancet Commission on Pollution and Health, in its October 19th report, is that “despite its substantial effects on human health, the economy, and the environment, pollution has been neglected” and its health effects “underestimated in calculations of the global burden of disease”. Considering all the attention that pollution issues have garnered over the years, that seems, on the face of it, a rather preposterous claim.
Yet dig a little deeper and the reason for that claim becomes apparent. In essence, while pollution certainly gets a lot of public and media attention, for the most part that has not translated into public policy that effectively curbs pollution. On the contrary, “in many parts of the world, pollution is getting worse”, particularly air, chemical and soil pollution in rapidly developing low and middle-income countries. Meanwhile the health and environmental consequences have been largely ignored, accepted as the cost of doing business, the price of development.
Contrary to previous estimates, which have found a lower burden of disease and premature death due to pollution, the Commission – which included three Canadians, including Professor Bruce Lanphear at SFU – concludes that “diseases caused by pollution were responsible for an estimated 9 million premature deaths in 2015 – 16% of all deaths worldwide”. To give some sense of proportion, the commission points out this is “three times more deaths than from AIDS, tuberculosis, and malaria combined and 15 times more than from all wars and other forms of violence”.
But these are ‘only’ deaths; on top of this we need to include all the illness and disability associated with pollution. The costs are enormous; the productivity losses are estimated to be up to 1.7 percent of annual health care spending in high-income countries and 7 percent in some rapidly developing middle-income countries.
And yet all this is an underestimate. Of the three main categories of pollutants, the Commission argues, only one group has been sufficiently well studied that the health effects are well understood and included in their estimate. This category includes in particular the links between indoor and outdoor air pollution and a number of conditions such as heart disease, chronic lung disease and cancer.
The big culprit here, according to the Commission, is combustion of fossil fuel and – in low income countries – biomass. This accounts for “85 percent of airborne
particulate pollution and for almost all pollution by oxides of sulphur and nitrogen” with the biggest problem being coal (which is why we need to close down the coal industry and drastically reduce fossil fuel use).
The second category is pollutants where we have some evidence of links to health problems and growing evidence of causation, but not enough to quantify the burden of disease. This includes associations between soil pollution with heavy metals and toxic chemicals at mines and industrial sites, and between fine particulate air pollution and conditions such as diabetes, and some diseases of the central nervous system.
The third category is, in many ways, the most troubling. It includes “new and emerging pollutants” such as certain pesticides (e.g. neonicotinoids and glyphosate), nano-particles, pharmaceutical wastes and substances that disrupt endocrines (hormones) or the developing neurological system. Moreover, some of these are widely dispersed in the environment and in our own bodies and the bodies of many other species, the phenomenon of ecotoxicity I referred to last week.
In light of the likely significant but as yet unquantified health effects of the second and third categories, the Commission believes that its estimate of 9 million deaths “could thus be the tip of a much larger iceberg”. So why is this significant health problem neglected? Why does any government in its right mind allow its population to be exposed to these pollutants at levels that are known to harm health?
I will explore the roots of this neglect in my next column, but sadly, I think that part of the reason is that, as the Commission notes, “Pollution disproportionately kills the poor and the vulnerable. Nearly 92% of pollution-related deaths occur in low-income and middle-income countries”. You can’t help but think that the cynical and sinister calculus is that these lives are cheap, and they don’t matter.
© Trevor Hancock, 2017